Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NM SALIVARY GLAND FNCTION STDY

Facility

$1,336.60

Service Code	HCPCS 78232
Hospital Charge Code	4500994
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM SALIVARY GLAND FNCTION STDY

Facility

$1,336.60

Service Code	HCPCS 78232
Hospital Charge Code	4500994
Hospital Revenue Code	341
Min. Negotiated Rate	$32.21
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.98
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.49
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$32.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$35.42

NM SALIVARY GLAND IMAGING

Facility

$1,336.60

Service Code	HCPCS 78230
Hospital Charge Code	4500995
Hospital Revenue Code	341
Min. Negotiated Rate	$32.21
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.98
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.49
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$32.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$35.42

NM SALIVARY GLAND IMAGING

Facility

$1,336.60

Service Code	HCPCS 78230
Hospital Charge Code	4500995
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM SALIVARY GLND/IMAG.W SERIAL

Facility

$1,448.92

Service Code	HCPCS 78231
Hospital Charge Code	4508010
Hospital Revenue Code	341
Min. Negotiated Rate	$34.92
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.68
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.34
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$34.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$117.87
Rate for Payer: Wellpoint Medicaid Managed Care	$38.40

NM SALIVARY GLND/IMAG.W SERIAL

Facility

$1,448.92

Service Code	HCPCS 78231
Hospital Charge Code	4508010
Hospital Revenue Code	341
Min. Negotiated Rate	$217.34
Max. Negotiated Rate	$217.34
Rate for Payer: Qualcare PPO/HMO/WC	$217.34

NM SALIVARY GLND IMG W/SER IMG

Facility

$1,336.60

Service Code	HCPCS 78232
Hospital Charge Code	4500996
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM SALIVARY GLND IMG W/SER IMG

Facility

$1,336.60

Service Code	HCPCS 78232
Hospital Charge Code	4500996
Hospital Revenue Code	341
Min. Negotiated Rate	$32.21
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.98
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.49
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$32.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$35.42

NM SCHILLING PART 1

Facility

$442.45

Service Code	HCPCS 78270
Hospital Charge Code	4500062
Hospital Revenue Code	341
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$168.13
Rate for Payer: Aetna Medicare Advantage	$132.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.82
Rate for Payer: Cigna Commercial	$221.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.74
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.37
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$10.66
Rate for Payer: Wellpoint Medicaid Managed Care	$11.72

NM SCHILLING PART 1

Facility

$442.45

Service Code	HCPCS 78270
Hospital Charge Code	4500062
Hospital Revenue Code	341
Min. Negotiated Rate	$66.37
Max. Negotiated Rate	$66.37
Rate for Payer: Qualcare PPO/HMO/WC	$66.37

NM SCHILLING PART II

Facility

$408.85

Service Code	HCPCS 78271
Hospital Charge Code	4500070
Hospital Revenue Code	341
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$155.36
Rate for Payer: Aetna Medicare Advantage	$122.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.26
Rate for Payer: Cigna Commercial	$204.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.66
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.33
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$9.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.83

NM SCHILLING PART II

Facility

$408.85

Service Code	HCPCS 78271
Hospital Charge Code	4500070
Hospital Revenue Code	341
Min. Negotiated Rate	$61.33
Max. Negotiated Rate	$61.33
Rate for Payer: Qualcare PPO/HMO/WC	$61.33

NM SHUNT CARDIAC

Facility

$996.85

Service Code	HCPCS 78428
Hospital Charge Code	4500534
Hospital Revenue Code	341
Min. Negotiated Rate	$24.02
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.06
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.53
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$24.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$26.42

NM SHUNT CARDIAC

Facility

$996.85

Service Code	HCPCS 78428
Hospital Charge Code	4500534
Hospital Revenue Code	341
Min. Negotiated Rate	$149.53
Max. Negotiated Rate	$149.53
Rate for Payer: Qualcare PPO/HMO/WC	$149.53

NM SHUNT CEREBRAL

Facility

$737.65

Service Code	HCPCS 78645
Hospital Charge Code	4500583
Hospital Revenue Code	341
Min. Negotiated Rate	$110.65
Max. Negotiated Rate	$110.65
Rate for Payer: Qualcare PPO/HMO/WC	$110.65

NM SHUNT CEREBRAL

Facility

$737.65

Service Code	HCPCS 78645
Hospital Charge Code	4500583
Hospital Revenue Code	341
Min. Negotiated Rate	$17.78
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,328.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$231.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,328.47
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.29
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$110.65
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$17.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$19.55

NM SPLEEN IMA ONLY W WO VASC F

Facility

$1,146.45

Service Code	HCPCS 78185
Hospital Charge Code	4500908
Hospital Revenue Code	341
Min. Negotiated Rate	$27.63
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.94
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.97
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$27.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$30.38

NM SPLEEN IMA ONLY W WO VASC F

Facility

$1,146.45

Service Code	HCPCS 78185
Hospital Charge Code	4500908
Hospital Revenue Code	341
Min. Negotiated Rate	$171.97
Max. Negotiated Rate	$171.97
Rate for Payer: Qualcare PPO/HMO/WC	$171.97

NM SR89 PROVISION OF PRODUCT**

Facility

$4,539.00

Service Code	HCPCS A9600
Hospital Charge Code	4500633
Hospital Revenue Code	342
Min. Negotiated Rate	$109.39
Max. Negotiated Rate	$14,967.04
Rate for Payer: Aetna Commercial	$11,278.04
Rate for Payer: Aetna Medicare Advantage	$13,434.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,967.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,967.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,146.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$456.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,967.04
Rate for Payer: Cigna Medicare Advantage	$2,902.44
Rate for Payer: Clover Medicare Advantage	$3,939.02
Rate for Payer: EmblemHealth Commercial	$12,439.02
Rate for Payer: Humana Medicare Advantage	$4,270.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,146.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.70
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$680.85
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$109.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,146.34
Rate for Payer: Wellcare Medicare Advantage	$4,146.34
Rate for Payer: Wellpoint Medicaid Managed Care	$120.28

NM SR89 PROVISION OF PRODUCT**

Facility

$4,539.00

Service Code	HCPCS A9600
Hospital Charge Code	4500633
Hospital Revenue Code	342
Min. Negotiated Rate	$680.85
Max. Negotiated Rate	$680.85
Rate for Payer: Qualcare PPO/HMO/WC	$680.85

NM SR89 THERAPY****

Facility

$361.00

Service Code	HCPCS 79400
Hospital Charge Code	4500641
Hospital Revenue Code	342
Min. Negotiated Rate	$54.15
Max. Negotiated Rate	$54.15
Rate for Payer: Qualcare PPO/HMO/WC	$54.15

NM SR89 THERAPY****

Facility

$361.00

Service Code	HCPCS 79400
Hospital Charge Code	4500641
Hospital Revenue Code	342
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$137.18
Rate for Payer: Aetna Medicare Advantage	$108.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.06
Rate for Payer: Cigna Commercial	$180.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.30
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.15
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$8.70
Rate for Payer: Wellpoint Medicaid Managed Care	$9.57

NM TC99 ALBUMIN 0019N350A1 DOS

Facility

$267.25

Service Code	HCPCS A9540
Hospital Charge Code	4500864
Hospital Revenue Code	343
Min. Negotiated Rate	$40.09
Max. Negotiated Rate	$40.09
Rate for Payer: Qualcare PPO/HMO/WC	$40.09

NM TC99 ALBUMIN 0019N350A1 DOS

Facility

$267.25

Service Code	HCPCS A9540
Hospital Charge Code	4500864
Hospital Revenue Code	343
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$133.62
Rate for Payer: Aetna Commercial	$101.56
Rate for Payer: Aetna Medicare Advantage	$80.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.15
Rate for Payer: Cigna Commercial	$133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.17
Rate for Payer: Qualcare PPO/HMO/WC	$40.09
Rate for Payer: UnitedHealthcare Community & State	$6.44
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

NM TC99 ARCITUMOMAB DOSE UP TO

Facility

$65.65

Hospital Charge Code	4500856
Hospital Revenue Code	343
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.70
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

Know your out-of-pocket cost for care.

All Charges